Nursing Elites

1. A unit director at a local hospital knows even leadership may face ethical dilemmas. Which of the following should the director take into consideration when dealing with an employee who is incompetent?

• A. The situation should be tolerated for as long as possible because of the amount of time and paperwork required to terminate an incompetent nurse.
• B. Incompetence only impacts the individual nurse.
• C. The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.
• D. Most nurse practice acts direct how to handle incompetent nurses.

Correct answer: C

Rationale: The director should follow her institution�s formal process for reporting and handling practices that jeopardize patient safety.

2. A resident on night call refuses to answer pages from the staff nurse on the night shift and complains that she calls too often with minor problems. The nurse feels offended and reacts with frequent, middle-of-the-night phone calls to 'get back' at him. The behavior displayed by the resident and the nurse is an example of what kind of conflict?

• A. Perceived conflict
• B. Disruptive conflict
• C. Competitive conflict
• D. Felt conflict

Correct answer: B

Rationale: The behavior displayed by the resident and the nurse is an example of disruptive conflict. In disruptive conflict, the parties involved engage in activities to reduce, defeat, or eliminate the opponent. The resident refusing to answer calls and the nurse retaliating with frequent calls to 'get back' at him exemplify behaviors aimed at causing disruption and conflict between them. Perceived conflict refers to each party's perception of the other's position, competitive conflict involves one side winning at the expense of the other, and felt conflict is about the feelings of opposition within the relationship, none of which fully capture the nature of the conflict displayed in this scenario.

3. Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)?

• A. The patient�s blood glucose level is 174 mg/dL.
• B. The patient has gained 2 lb (0.9 kg) since yesterday.
• C. The patient is scheduled for a chest x-ray in an hour
• D. The patient�s blood urea nitrogen (BUN) level is 52 mg/dL.

Correct answer: D

Rationale:

4. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?

• A. Infuse 1 liter of normal saline per hour.
• B. Give sodium bicarbonate 50 mEq IV push.
• C. Administer regular insulin 10 U by IV push.
• D. Start a regular insulin infusion at 0.1 units/kg/hr.

Correct answer: A

Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.

5. What is the primary focus of a patient safety program?

• A. To reduce healthcare costs
• B. To improve clinical outcomes
• C. To enhance patient satisfaction
• D. To comply with regulatory standards

Correct answer: C

Rationale: The primary focus of a patient safety program is to enhance patient satisfaction by ensuring safe practices. While reducing healthcare costs and improving clinical outcomes are important aspects influenced by patient safety programs, the main goal is to prioritize patient well-being and satisfaction. Complying with regulatory standards is essential but not the primary focus; it is a means to achieve safe practices for the benefit of patients.

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